Angiogenesis for the treatment of vascular diseases.

Critical ischemia of the limbs or myocardium is frequently accompanied by diffuse distal vascular disease making it unapproachable by conventional revascularization techniques. Pharmacological treatment is available for coronary artery disease but there has been no effective medical therapy for advanced ischemia of the limbs. In the search for alternative treatments for patients with diffuse distal disease, recent developments in vascular biology have directed attention towards use of vascular growth factors. Therapeutic angiogenesis has shown promising results in early clinical studies as shown by improved clinical status and in some cases angiographic studies. We employed an angiogenic strategy that utilizes enhanced vascular endothelial growth factor (VEGF) in a fibrin network, in two patients with critical limb ischemia. Objectively, we were able to demonstrate angiographically the growth of new blood vessels after administration of VEGF and fibrin composite. Fibrin glue provides for the slow release of and prolongs the availability of VEGF, thereby sustaining angiogenesis resulting in improved oxygenation of ischemic tissue. Further investigations are warranted to validate if angiogenesis may increase blood flow in patients with advanced vascular disease.